Refers to the internal dimensions of the ventricle, ideally given as an indexed volume, which is then referenced to age and gender matched normal ranges.
Refers to the thickness of the ventricular myocardium. The wall may be thicker due to phyiological hypertrophy (athletes), pathological hypertrophy (hypertropic cardiomyopathy), infiltration (cardiac amyloidosis) or oedema (myocarditis).
Ejection fraction (EF)
Average global longitudinal peak systolic strain (GLPSS)
Diastolic function is assessed via a combination of echocardiographic parameters including the ratio of ‘early mitral’ inflow to the ‘atrial kick’ inflow velocities, mitral inflow deceleration time, left atrial size and estimated systolic pulmonary pressure. There are four grades:
There are reference ranges available for standardised measurements of RV cavity size (base, mid cavity and length from apex to base). Often cardiologists may elect to report this qualitatively (i.e. ‘normal size’ or ‘mildly increased’), as it is often quite difficult to accurately characterise with standard 2D echo.
Right ventricular dilatation is particularly important in pulmonary hypertension and when assessing the haemodynamic impact of atrial-level shunts.
Best measured from a dedicated zoomed image of the sub-costal 4-chamber (normal wall thickness is ~5 mm). This is often qualitatively reported.
RV wall thickness is particularly important in the context of:
Tricuspid annular plane systolic excursion (TAPSE)
Right ventricular S wave velocity (RVS’)
Right ventricular strain
Left atrial size and volume indexed to BSA
Right atrial size indexed to BSA
The number of cusps should be reported (i.e. trileaflet or bicuspid)
Leaflet mobility and presence of aortic stenosis
Leaflet competence (aortic regurgitation)
The mitral valve is a complicated structure, and should be thought of as consisting of leaflets (anterior and posterior), chordae, papillary muscles and an annulus. The anterior leaflet is the larger of the two and consists of 3 segments that oppose the 3 scallops (indentations in the leaflet tissue) that comprise the posterior leaflet
The presence, severity and mechanism should all be described in a standard report (of note, trivial mitral regurgitation is generally physiological, i.e. normal variant)
Primary mitral regurgitation – problem with the leaflet
Secondary mitral regurgitation – leaflet structure is intact, but the MR is due to a secondary mechanism such as dilatation of the annulus or papillary muscle dysfunction (as seen in ischaemic heart disease)
Presence or absence of tricuspid regurgitation and stenosis should be mentioned
Estimation of pulmonary pressure
Often not well visualised (however generally speaking right-sided valves are seen better with trans-thoracic echocardiography than via trans-oesphageal echocardiography)
The presence or absence of regurgitation and stenosis should be mentioned
Sometimes the pulmonary artery may be enlarged in conditions such as pulmonary hypertension
Size of the aortic root, proximal ascending aorta and aortic arch should be mentioned. The aorta may dilate in conditions such as hypertension or aortopathies such as those seen with bicuspid aortic valves and Marfan’s syndrome.
Normal reference ranges depend on sex, body surface area (except in extreme obesity) and age (often useful to use an indexed value or a Z-score for children / adolescents):
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